CT diagnosis of Meckel diverticulum in a paracolic internal hernia

Imaging congenital anomalies of the ileum in adults:a pictorial review

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

MECKELS DIVERTICULUM WITH MESENTERY AS A RARE CAUSE OF CLOSED LOOP OBSTRUCTION-A CASE REPORT

Meckel's Diverticulum is most common congenital anomaly of gastrointestinal tract. It arises from Antimesenteric border of the small bowel [1]. In contradiction, a case encountered at our institution where a 32-y old female presented with complaints of pain abdomen since 3 days, vomiting's since 3 days, obstipation since 3 days and distention since 1 day. On examination abdomen is distended, diffuse tenderness present all over the abdomen with no bowel sounds and collapsed rectum with no fecal staining per rectally. Imaging studies on ultra-sonography shown dilated small bowel loops with max diameter of 3.1cm showing to and fro peristalsis. On CT abdomen multiple dilated small bowel loops with air uid levels with maximum diameter of 4.1cms with collapsed terminal ileum and large bowel. ?Closed Loop Obstruction. Emergency exploratory laparotomy was planned and shown Meckel's diverticulum with mesentery present on anti-mesenteric border with mesentery extending from mesenteric border to tip of Meckel's diverticulum with internal herniation of proximal ileum between the Meckel's and its mesentery causing closed loop obstruction noted at 60cms from IC junction for which herniated bowel loops was released with diverticulectomy followed by anastomoses of proximal and distal ileal loops. Resected Meckel's sent for histopathological examination and cut section showed mucosa, sub-mucosa, muscularis propria and serosa. Mucosa shows chronic nonspecic inammation, sections from the adjacent area's shows hyperplastic mucosa, hypertrophied muscularis layers and serosa with congested blood vessels with feature's consistent with Meckel's diverticulum. Patient was followed for 6 months, and the course was un-eventful.

A review of internal hernias related to congenital peritoneal fossae and apertures

Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.

An internal hernia caused by Meckel's diverticulum: a case report

BACKGROUND

Meckel's diverticulum is a remnant of the omphalomesenteric duct. It can lead to intestinal perforation, obstruction and gastrointestinal bleeding. While the internal hernia caused by Meckel's diverticulum is rarely reported.

CASE PRESENTATION

We report a case of a 45-year old female patient who presented with intestinal obstruction and on laparotomy was found to have Meckel's diverticulum with internal hernia causing intestinal gangrene. Segmental bowel resection was performed and the patient had uneventful recovery.

CONCLUSIONS

In patients with acute intestinal obstruction without previous abdominal surgery, Meckel's diverticulum and its complications should be suspected.

Transthoracic Littre's hernia presenting with faecopneumothorax following perforation of the Meckel's diverticulum: a late complication of oesophagectomy

A Littre's hernia is an unusual phenomenon where a Meckel's diverticulum protrudes through a potential abdominal opening. We wish to present a unique case of a 79-year-old man with respiratory distress following a fall from standing, initially managed as a haemothorax. After a chest drain was placed, bowel contents were drained from the pleural cavity and he was taken to theatre. He had a history of minimally invasive oesophagectomy for cancer and had subsequently developed a diaphragmatic hernia. A blind ending diverticulum with a perforation at its tip was found in the left oblique lung fissure that was subsequently confirmed histologically as a perforated Meckel's diverticulum. The patient had a prolonged stay on the intensive care unit with a left-sided empyema that was managed radiologically prior to discharge. Unfortunately 4 months postoperatively, he passed away from hospital-acquired pneumonia on a rehabilitation ward.

Unusual cause of small bowel obstruction: mesodiverticular band of Meckel's diverticulum demonstrated by CT

Small bowel obstruction resulting from the mesodiverticular band is a rare complication of Meckel’s diverticulum and usually presents a diagnostic challenge. We present a case of small bowel obstruction due to the mesodiverticular band of Meckel’s diverticulum with CT scan findings.

Meckel's diverticulum mesentery along with its band forming a hernial sac: A rare case of internal herniation

INTRODUCTION

Meckel's diverticulum is the most common congenital gastrointestinal anomaly. However, only 2% of cases are symptomatic. It can cause intestinal obstruction by various mechanisms as volvulus, adhesions, Littre's hernia, intussusception.

CASE PRESENTATION

An unusual case of internal herniation of small bowel loops into complete hernia sac formed by unusual mesentery of Meckel's diverticulum which was present upto the adhesive band, extending from tip of the Meckel's diverticulum to the adjacent mesentery of small intestine leading to small bowel obstruction (SBO). Diverticulectomy with resection of adjacent ileum with ileo-ileal anastomosis was done.

DISCUSSION

Internal herniation by MD leading to SBO is an extremely rare complication. In literature, cases of internal hernia through mesentry of Meckel's diverticulum, through mesodiverticular band, adhesion of inflamed end of MD to corresponding base of mesentry, fibrous cord extending upto umblical wall have been reported but in our case, patient had both adhesion band along with internal herniation into sac formed by unusual mesentry of the meckel's diverticulum and the adhesion band. Preoperative diagnosis is often difficult with only 6-12% of cases diagnosed correctly. Surgical intervention is indicated for patients with intestinal obstruction or high risk of incarceration.

CONCLUSION

Meckel's diverticulum causing internal hernia is rare event. It's presentation due to herniation of bowel loops into sac formed by mesentery attached to diverticulum and the adhesion is rarest, with non specific signs and symptoms. Early diagnosis and prompt treatment prevent further complications.

Radiologist's perspective for the Meckel's diverticulum and its complications

The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.

Small intestinal strangulation due to a rare type of primary internal hernia

Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.

3D CT imaging in clinical practice

Recent technological advances in multidetector computed tomography (MDCT) have enabled 3D diagnostic imaging with superb spatial and temporal resolution. This often provides useful information on precise detail and relationships.

Internal hernia associated with Meckel's diverticulum in 2 pediatric patients

We report 2 pediatric cases of small bowel obstruction due to a Meckel's diverticulum complicated with internal hernia. Abdominal multidetector computed tomograms with multiple planar reconstructions revealed a bridge-like lesion with inconspicuous mucosal folds in the right lower quadrant formed by adhesion of the tip of Meckel's diverticulum with the adjacent mesentery, with ileal loops converging at the "bridge" and engorged mesenteric vessels. These 2 cases highlight the feasibility of multidetector computed tomography, especially in the ED, in revealing this unusual etiology of small bowel obstruction.

Red herring: a rare cause of small bowel obstruction

This is a case report of a 73-year-old man with a small bowel obstruction secondary to an incarcerated paracaecal hernia. His large right inguinal hernia, initially suspected as a potential source of obstruction, turned out to be a red herring. Congenital internal hernias are a very rare cause of bowel obstruction. In this report we review the literature and embryology behind these uncommon occurrences.